Provider Demographics
NPI:1033284021
Name:LEWIS, PATRICIA G (LICSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:G
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 BOSTON POST RD E
Mailing Address - Street 2:SUITE 450
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3527
Mailing Address - Country:US
Mailing Address - Phone:508-460-9633
Mailing Address - Fax:508-481-2609
Practice Address - Street 1:221 BOSTON POST RD E
Practice Address - Street 2:SUITE 450
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3527
Practice Address - Country:US
Practice Address - Phone:508-460-9633
Practice Address - Fax:508-481-2609
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1038911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
005855OtherVALUE OPTIONS
103891OtherTUFTS
MAP03210OtherBLUE CROSS BLUE SHIELD
103891OtherTUFTS